Recommendations to the CongressU.S. Government Printing Office, 1990 - 21 pages |
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ACCESS TO HEALTH Additional Cost Allow all uninsured Americans Without Health billion budget cost of coverage cost-sharing coverage or contribute coverage target delivery employees and non-working employees of firms employers families Federal Costs federal government federal poverty level fewer than 25 Firms with fewer home and community-based Home Care Nursing Home Care Total home reimbursement rates Improve Nursing Home incomes below 200 Increase From Phase Insurance reform long-term care insurance managed care manager Medicaid medical malpractice Medicare meet these criteria minimum benefit package Net New Federal non-working dependents Number of Uninsured Nursing Home Care Nursing Home Program Nursing Home Reimbursement nursing home users persons PHASE-IN SCHEDULE Physician plan is financed premium prenatal care preventive services private long-term provide coverage provide private insurance public plan quality assurance required to provide specified benefit package surance tax credits/subsidies three-month front-end Total Costs Phase underserved Uninsured Children Uninsured Covered uninsured employees Uninsured Now Covered
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Page 7 - ... departments. * States retain the responsibility for regulating financial stability of insurers. 5. Specified Benefit Package * Basic services including hospital and surgical services, physician services, diagnostic tests and limited mental health services (45 inpatient days and 25 outpatient visits) . * Preventive services including prenatal care, well-child care, mammograms, pap smears, colorectal and prostate cancer screening procedures and other preventive services that evidence shows are...
Page 10 - ... medical referrals, nutrition counseling and eligibility determinations for welfare and housing programs) . * Undertake and support research and evaluation efforts to determine the effectiveness of primary care models and services aimed at addressing the needs of underserved communities. * Support programs of health promotion, disease prevention, risk reduction and health education toward the reduction of excess morbidity and mortality and toward the increase of healthy lifestyles. Federal support...
Page 3 - The federal government finances the home and community-based care program and the three-month "front-end" nursing home care. * The federal and state governments share financial responsibility for the NHP. * All three components of the plan are administered by the states according to federal guidelines. * States are responsible for cost containment, quality assurance and consumer protection within federal standards. 3 . Private sector role * Private long-term care insurance fills gaps not covered...
Page 9 - Issues .1 . Expanding health care insurance coverage should reinforce --not replace — support for primary care delivery systems targeted at the poor and underserved. Organized primary care providers (eg, local health departments and community health centers) should be recognized and reimbursed by private and public payers on the same basis as all other providers.
Page 9 - Initiatives 1. Insuring all Americans through a job-based/public program and reforming the private insurance market will distribute the costs of insurance more fairly by: * Reducing the cost-shift that now occurs from the uninsured "to the insured population. * Reducing the cost-shift that now occurs from employers who do not provide insurance to employers who cover their workers and dependents. * Assuring small business access to a minimum benefit package at predictable rates, regardless of employees
Page 16 - ... 2. The federal government encourages the development of private long-term care insurance through clarification of the tax code. This includes: * Treating, for tax purposes, the premiums paid and the benefits received as health insurance. * Enabling qualified long-term care policies to be sold in - employers' cafeteria plans. 3. The federal and state governments share responsibility for standards and oversight of the private long-term care market. * The federal government establishes minimum standards...
Page 8 - ... includes : * The development of national practice guidelines and standards of care, already begun by the newly created Agency for Health Care Policy and Research. Physicians and physician organizations should be widely utilized in establishing and reviewing practice guidelines and standards of care. * The development and implementation of a uniform data system that covers all health care encounters, regardless of payment source or setting. These data would provide a common foundation for all...
Page 8 - A self-financed voluntary reinsurance mechanism through which insurers could reinsure high-risk persons or groups would be established. Quality Assurance 1. The federal government should develop and implement a comprehensive national system of quality assurance which includes : * The development of national practice guidelines and standards of care, already begun by the newly created Agency for Health Care Policy and Research. Physicians and physician organizations should be widely utilized in establishing...
Page 14 - Individuals pay 20% of the costs of care up to a maximum of the national average cost of nursing home care. * The federal government subsidizes the coinsurance at least for persons with incomes below 200% of the federal poverty level. Financing 1. The federal government is responsible for the home and community-based care program and the three-month "front-end
Page 9 - ... malpractice liability, that the Prospective Payment Assessment Commission and the Physician Payment Review Commission review costs under the program proposed by the Commission and that a National Cost Containment Commission, made up 'of experts, public and private payers, providers and consumers, be created to assess cost experience and initiatives to contain costs in the public and private sectors and to make periodic recommendations to the Congress on federal initiatives. Delivery Issues ....